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  • Title: Maintenance of behavioral change in a cohort of homosexually active men.
    Author: McCusker J, Stoddard AM, McDonald M, Zapka JG, Mayer KH.
    Journal: AIDS; 1992 Aug; 6(8):861-8. PubMed ID: 1418783.
    Abstract:
    OBJECTIVES: To assess associations of perceptions of sexual behavior change with actual risk behaviors and psychosocial variables, and to determine whether perceptions of behavior change predict subsequent behavior. DESIGN: Cohort study of homosexually active men. SETTING: Community health center in Boston, Massachusetts, USA. PATIENTS, PARTICIPANTS: Two hundred and sixty-two cohort members who participated in follow-up in 1989 and who had at least one subsequent visit. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Composite risk behavior variable, based on unprotected anogenital contact and number of partners. RESULTS: Of the 96% who had effected behavior change, 47% perceived that they were able to maintain those changes consistently and 58% wanted to make more changes. Perceptions of consistent maintenance were associated with lower risk behavior, lower perceived riskiness of behaviors and susceptibility to AIDS, and fewer barriers to behavior change. Desire for more change was associated with increased behavioral effort, fewer barriers to condom use, and greater perceived riskiness of current behavior. Among those with lower risk behaviors, perceived inconsistent maintenance predicted relapse to more risky behavior at the following visit. CONCLUSIONS: Perceived maintenance of behavior change is potentially useful in identifying individuals at risk of relapse from safer sex. Public health researchers followed a cohort of 322 homosexually active male clients enrolled at a community health center in Boston, Massachusetts between January 1985-April 1987 at 6-month intervals to examine cross-sectional and longitudinal data on perceptions of sexual behavior change among initially asymptomatic and homosexually active men. Only 262 completed the questionnaire addressing perceptions of behavior change. 40% of the 60 students who did not complete the questionnaire tested positive for HIV compared with 22% of those who did complete the questionnaire (p.01). High risk included unprotected anogenital contact with multiple partners. HIV status was not associated with behavior change. Behavior change was associated with alcohol or drug use during sex for men of low or modified high risk at baseline (p=.01). 96% of 262 men achieved sexual behavior change after learning about AIDS. 58% hoped to make additional changes. 47% thought that they could always sustain the changes. Men who were not consistent in practicing behavioral changes were more likely to want to make more changes (p.001). Men who perceived themselves to practice inconsistent behavior did indeed practice high risk behavior (p=.005). Those who perceived themselves to consistently practice lower risk behavior at follow up were 2.07 times more likely to practice safer behavior than those who did not see themselves as practicing consistent behavior. Follow up data showed that men were somewhat more likely to return to risky behavior than change to safe behavior (p=.07). In fact, men who at baseline participated in high risk behavior were 1.57 times likely to continue the high risk behavior. For men who at baseline participated in low risk behavior tended to continue that behavior (odds ratio=8.88). The researchers concluded that perceived maintenance of behavior change could help health professionals determine which people are at a risk of reverting to risky sex behavior.
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